Provider Demographics
NPI:1841953759
Name:FAZIO, LOUIS JAMES
Entity type:Individual
Prefix:
First Name:LOUIS
Middle Name:JAMES
Last Name:FAZIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32018 HIGHWAY 59
Mailing Address - Street 2:
Mailing Address - City:MAUD
Mailing Address - State:OK
Mailing Address - Zip Code:74854
Mailing Address - Country:US
Mailing Address - Phone:405-374-1225
Mailing Address - Fax:
Practice Address - Street 1:32018 HIGHWAY 59
Practice Address - Street 2:
Practice Address - City:MAUD
Practice Address - State:OK
Practice Address - Zip Code:74854
Practice Address - Country:US
Practice Address - Phone:405-374-1225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-18
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator